Category Archives: Safeguarding

“Not good enough, CQC”

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John Burton, a social care consultant and writer, gives his personal response to the recent Safeguarding Adults Review on Mendip House. John is the author of Leading Good Care, JKP, 2015 and What’s wrong with CQC?, Centre for Welfare Reform, 2017. (973 words)

I’ve been reading the safeguarding review of Mendip House, a care home for adults with autism in Somerset. (Safeguarding Adults Review. Mendip House by Margaret Flynn, January 2018.) The home was owned and managed by The National Autistic Society (NAS), regulated by the Care Quality Commission (CQC), and the residents were placed there by local authority commissioners from all over the UK but none from Somerset itself.

Mendip House has been described as “Winterbourne View without the cameras”: a thuggish gang of staff assaulted, taunted, and stole from the residents; managers were weak and complicit. Whistleblowers told the CQC and the senior management of The NAS, but—as at Winterbourne View—they were repeatedly ignored or fobbed off. The NAS made ineffectual internal investigations but did not alert the CQC or the local safeguarding service as they should have done. The placing authorities failed to monitor the care, safety and welfare of their residents, or whether the high fees were value for money. Whistleblowers left while the perpetrators of the abuse were ticked off but remained in post. In other words, no one did their job properly or considered the residents who remained at the mercy of a horrible regime. Continue reading →

Young people and gambling in changing times: implications, risks and harms?

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Caroline NorrieStephanie BramleyResearchers Caroline Norrie (right) and Stephanie Bramley from the Social Care Workforce Research Unit at the Policy Institute at King’s College London attended the 5th annual Harm-Minimisation Conference on Wednesday 6 December and Thursday 7 December 2017. (1,233 words)

GambleAware, the charity funded by gambling operators to fund treatment services, education and research to help minimise gambling-related harm in Great Britain, held its annual conference at The King’s Fund, London in December. This was a jam-packed two days of speakers and this year the focus was on two issues: 1) gambling and the implications for young people, and 2) gambling and sport. In this blog post we focus on the first subject, but a summary of content relating to gambling and sport is in GambleAware’s own conference report. Continue reading →

Wandsworth Adult Safeguarding Conference – Modern Slavery and Partnership Working

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Caroline NorrieCaroline Norrie is Wandsworth Enter and View Representative and Researcher, Social Care Workforce Research Unit, KCL. (612 words)

Public sector practitioners from across the Borough came together on 27 November, 2017 at the annual Wandsworth Safeguarding Conference – Working in Partnership, which took place in Wandsworth Civic Centre Town Hall.

The morning was dedicated to raising awareness of Modern Slavery and Human Trafficking. Attendees were informed about the high prevalence of modern slavery—the recruitment, transportation, transfer, harbouring or receipt of persons. Trafficking was defined as: the movement of people by means such as force, fraud or deception with the aim of exploiting them.

Tatiana Gren Jardan, Director of Strategy at the Office of the Independent Anti-Slavery Commissioner, discussed the role of local authorities in fighting modern slavery—and how staff may be able to identify cases in their everyday work. Tamara Barnett, from the Human Trafficking Foundation, then outlined the duties professionals have in identifying and supporting victims. Since the passing of the Modern Slavery Act 2015 specified public authorities (including Local Authorities) have a duty to report details of suspected cases of modern slavery to the Home Office. The National Referral Mechanism (NRM) framework can then be used (if an adult victim consents) with offering 45 days ‘reflection and recovery’ time for a victim to receive appropriate support. Continue reading →

Safeguarding Diogenes

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James Fuller is a Peer Researcher, Expert by Experience and a Support Worker at a Day Centre for people who are homeless in London. (1,200 words)

Brighton and Hove Safeguarding Adults Board recently published the key messages arising from a review. A Safeguarding Adults Review is held when an adult in the local authority areas dies as a result of abuse or neglect. In this case, the adult was sleeping rough and had been identified as ‘difficult to engage’. Chris Scanlon and John Adlam have written extensively about Diogenes, homelessness and what to do about people whose refusal to be included remains a problem for themselves and society as a whole. This review brought into sharp focus some of these same issues. Namely how can we safeguard Diogenes? According to the essayist Plutarch, the philosopher Diogenes the Cynic (412-323BC) lived in a barrel in Corinth and spent his time pouring vitriol on his fellow beings, who he roundly despised. One day, Alexander the Great invited Diogenes to a gathering, but the drum-dweller declined. Instead of having Diogenes executed, the usual outcome for disrespecting world conquerors, Alexander went down to see him.  Having greeted Diogenes, Alexander asked him if he wanted anything. Diogenes replied: “Yes, stand a little out of my sunshine” (Plutarch, Alexander, 14 Cf.). Continue reading →

Adult Social Care – where’s the evidence?

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Jo Moriarty Nov 2014bJo Moriarty and Martin Stevens are Senior Research Fellows at the Social Care Workforce Research Unit. (1,192 words)

People often talk about the absence of a social care evidence base, but ‘patchy’ is a far better description. Until we arMartin Stevense more explicit about this, it will be difficult to make progress in achieving evidence based policy and practice. We took part in two Meet the Researcher sessions at an event jointly organised by Research in Practice for Adults (RIPfA), the British Association of Social Workers (BASW) and the Association of Directors of Adult Social Services (ADASS). They were part of a day-long seminar designed to bring Directors and Assistant Directors of Adult Social Care and researchers together to discuss current and future adult social care research. Continue reading →

Risk, Safeguarding and Personal Budgets: exploring relationships and identifying good practice

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Martin StevensDr Martin Stevens is Senior Research Fellow at the Social Care Workforce Research Unit in the Policy Institute at King’s. (900 words)

Published today are our findings from this timely NIHR-SSCR funded study, which aimed to provide evidence about the impact of using different forms of Personal Budgets on risks of abuse, to explore practice responses to the increased emphasis on using Personal Budgets and the experiences of Personal Budget holders who had been the subject of a safeguarding referral (suspected abuse or neglect). This collaborative research (undertaken by researchers from King’s, the University of York and Coventry University) was driven by our awareness of contradictory perceptions held by practitioners and other researchers. We had heard views that people on Direct Payments (one main form of Personal Budgets) were more at risk of abuse than other social care users, but on the other hand that the increased control offered by Direct Payments was a protective factor. In order to provide some evidence to address these contradictions, we re-analysed national and local data on safeguarding referrals and take-up of the different forms of Personal Budget. Continue reading →

Making Safeguarding Personal (MSP) – the way forward for adult social care

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by Caroline Norrie, Research Fellow at the Social Care Workforce Research Unit at King’s College London. (952 words)

Professionals working in the adult social care field gathered at Friends House in Euston, London, on 30 June 2014 to share knowledge and experiences of Making Safeguarding Personal (MSP). MSP was initiated by the Association of Directors of Adult Social Services (ADASS) and the Local Government Association (LGA) as a sector-led response to concerns that adults at risk are not being involved in investigations and decisions when councils have concerns about abuse or neglect (adult safeguarding).

Supported by funding from Department of Health (DH) and the LGA, this improvement programme started in 2011/12 with the development of a toolkit. In 2012/13 five pilot councils signed up to the scheme and this year 53 councils participated. The programme has been given increased funding to continue next year across further English councils. Continue reading →

What can the city banks learn from social care?

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The Registered Managers’ Programme from The National Skills Academy for Social Care aims to better equip Registered Social Care Managers to meet the challenges they face, to reduce their isolation by networking them at local and national level, and to enable them to recognise their leadership role. As part of the Programme, they are funding Local Networks to support Registered Managers on the ground, either where demand has been identified but no Network exists, or to strengthen and expand existing ones.

One such network has recently been established in Cumbria with support from the Social Care Workforce Research Unit at King’s College London, and it builds on earlier work around communities of practice. For more information contact michelle.cornes@kcl.ac.uk

This post was written by the members of the Cumbria Registered Social Care Managers’ Network following their meeting last month.

The focus of this meeting (4 June 2014) was celebrating the work of the huge number of social care workers who do a great job every day and make a really positive difference to the lives of people who need care and support. Inevitably though, the conversation moved to discussing the recent Panorama programme (Behind Closed Doors, 30 April 2014) on abusive care, and the impact programmes like this have on staff in the sector. That led to us thinking about what registered social care managers can do to raise the profile of care that is caring and compassionate?

Cumbria Registered Social Care Managers’ Network

The Cumbria Registered Social Care Managers’ Network at the June 2014 meeting

For the front-line care workers in attendance at this meeting, programmes like Behind Closed Doors are far removed from their day-to-day experiences of delivering care. A good day for some starts with crumpets, toast and jam and a chance to catch up with each other (called a ‘hand over’ in the jargon). There are enormous challenges in delivering good quality care—for example how to be personalised, compassionate and ‘quick’ (in your 15 minute time slot with each resident). Work is often stressful, physically demanding (12 hour shifts) and emotionally draining. Needless to say, the situation is not helped by the current climate of austerity and chronic underfunding. However, the job brings with it enormous rewards and a great sense of personal satisfaction. At the heart of the work is your team, like a family almost, and all the emotional benefits which flow from being collegiate.

Added to this, is the sense that you are making a very real and positive difference to people’s lives. In this business it is the ‘smiles and the thank yous’  that count for most… The six figure bonuses, pay rises, company cars and expenses said to be absolutely essential to recruit and retain the ‘best’ staff in the more compassionate(less) industries are seemingly not so important in social care. Maybe the city banks have something to learn from social care managers in this respect?

Cumbria Registered Social Care Managers’ Network

The Cumbria Registered Social Care Managers’ Network at the June 2014 meeting

Where programmes like Panorama can have a particularly detrimental impact is that they can work to undermine the confidence and integrity of some social care managers. The desire to ‘protect’ the public from abusive care often sees the inspectorates and commissioners of services imposing further layers of monitoring and regulation. However, unless carefully implemented as part of a wider culture of learning and improvement, this can quickly lead to a ‘them’ and ‘us’ scenario in which there is a lack of trust and authentic partnership working. While the ‘best managers’ will follow the rules and regulations, reporting ‘poor practices’ or any ‘safeguarding’ incidents as they are required to do, they can be left feeling demoralised and ‘brow beaten’ by the response. ‘Poor managers’ meanwhile will keep their heads down; they will not engage externally and will remain largely hidden from view, that is, until the television cameras go in.

How to engender trust and authentic relationships (the ‘smiles and the thank yous’) between commissioners and providers of social care services is a question we shall return to in future meetings. Celebrating the role of the social care worker and raising the profile of ‘good care’ has just been a first step.

For more information about this post please contact Michelle Cornes, Senior Research Fellow at the Social Care Workforce Research Unit at King’s College London. The Unit is part of The Policy Institute @ King’s.

Challenge the CQC

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Caroline Norrie, Research Fellow at the Social Care Workforce Research Unit at KIng’s College London, and Esther Njoya, Research Intern at the Unit, report on a meeting held earlier this month at which the Care Quality Commission (CQC) was put on the spot by parliamentarians, professionals and the public.

The public had a chance to ‘challenge the CQC’ at an event held on 11 June at the House of Commons. This was an opportunity for the public, patients, and health and social care professionals to question representatives of the Care Quality Commission (CQC) about its work and especially the proposed changes to the regulation of primary and integrated care.

Held under the aegis of the All-Party Parliamentary Health Group, the meeting was chaired by Dr Sarah Wollaston MP with a panel made up of Chairman of the CQC, David Prior and Chief Inspector of General Practice, CQC, Prof Steve Field. Dr Sarah Wollaston opened the meeting with a brief description of the role of the CQC as independent of government and committed to transparency and the integration of health and social care.

Chairman of the CQC, David Prior

Chairman of the CQC, David Prior

Following the Winterbourne View TV exposé and Serious Case Review the CQC has been making significant changes. These are summarised in its strategy, Raising standards, putting people first – Our strategy for 2013 to 2016, which it has been consulting on. As part of a new inspection regime, the five new key domains the CQC will be inspecting in all services are safety, effectiveness, caring, responsiveness to people’s needs and leadership. The new style inspections are being trialled in hospitals, mental health and community health services, and, since April 2014, in adult social care services and GP practices.

As has been widely reported, inspections are now being carried out by specialists (including experts by experience) within professional areas rather than generalists. Services will soon be graded as outstanding, good, requires improvement or inadequate. The CQC hopes this new grading system will encourage service improvement. The CQC has also undertaken a review of care homes and found about 3,000 care homes with no qualified registered managers; in some of these the owners have been penalised. Finally, a new aim of the CQC is to understand and measure service users’ experiences of integrated working. Final plans will be published in September 2014 and come into effect in October 2014. This meeting was part of CQC’s strategy to engage the public in this change process.

Professor Field outlined in more detail his vision for inspection in primary care, which includes improved access to care for vulnerable people (such as homeless people, people with learning disabilities, and sex workers, among others). The CQC will use ‘levers’ to improve integrated care and its commissioning. The aim is to ‘celebrate good practice as well as shining the light on poor practice.’  He outlined all the areas that are covered by CQC primary care inspection including GPs, dentistry, mobile doctors (e.g. the 111 service) medicine management, prisons and safeguarding.

The majority of this forum was taken up with discussion around a wide range of questions from the audience.

Baroness Hollins, a prominent Learning Disabilities (LD) campaigner, urged the panel to introduce levers to ensure GP practices fulfilled the regulation of noting when a patient has a learning disability. She asked whether the CQC had made any headway in implementing the recommendations set out in the Confidential Inquiry into premature deaths of people with learning disabilities (CIPOLD). She stated that 37% of the deaths of learning disabled people were preventable—making this a discriminated against group. Prof Steve Field replied he was taking notice of the comments and that such implementation might be possible using intelligent monitoring (a new system being developed to combine informal intelligence and formal performance management data).

Several service users and carers used this meeting to complain about lack of joined-up services and inequality between London boroughs in the provision of mental health services. Suggestions were made about providing crisis phone lines, which might reduce hospital admissions. The speakers took notice of these comments and also offered the audience information about making complaints to local Health and Well-being Boards (HWBs) and the CQC call centre in Newcastle.

A representative from Healthwatch asked about links with the CQC and how to make the most of their work (e.g. their role in being able to enter and view services) while avoiding duplication of roles. Prof Steve Field answered that the CQC was focused on ‘listening to people on the ground’ and the HWBs acted like the ‘eyes and ears of the CQC’ and so both organisations should be working together. It was not entirely clear how these mixed metaphors would work locally,

Concerns specifically relating to GPs were raised—for example, out-of-hours services, the trend for phone rather than face-to-face consultations, and regulation of single-doctor practices. Service users asked when electronic patient records were going to be introduced and whether patients would have permission to check and amend their own records. Questions were also asked about regulation of follow-up-care and post-discharge services and insurance for independent midwives.

Another representative from a Healthwatch organisation, who declared that they were willing to support individuals who wanted to expose acts of neglect and abuse in care homes as whistleblowers or witnesses, asked whether there were avenues that such organisations could use to effectively collaborate with the CQC. She observed that they could contribute to the CQC’s work in providing oversight roles for inspections, regulation and monitoring, as it was evident to her that the CQC had overlooked previous cases of abuse scandals—for example the case in The Old Deanery home, which was shown by Panorama at a time when CQC was actually carrying out an ongoing inspection. Professor Field replied by saying that it was unfortunate that such an incident had happened while still under their scrutiny, but that at the time they had relied on information from the management of the home. He reiterated that the CQC welcomes the contribution of Healthwatch organisations who are able to provide information.

In contrast, Paul Beresford MP noted his concern about over-regulation and suggested closer working together of the General Medical Council (GMC) inspections and the CQC. Professor Field replied that this was in the pipeline, and there were general murmurs of approbation to this news.

A representative from the care home sector then put forward the case for private providers. He said there was a danger that good quality operators offering services for people with long-term conditions would be driven out of the sector due to the growth of regulation. He called for increased funding and more training to be made available for care home managers. Prof Steve Field agreed, but noted that care homes should also take some responsibility for training and ensuring that their members of staff have care home management skills and professional qualifications.

One member of the audience questioned whether the CQC has capacity to undertake this more stringent inspection regime. Professor Field replied that the CQC was recruiting more staff and that it did have capacity to undertake the work. The best providers will only be regulated once every two years, rather than annually as is currently the case.

As researchers currently involved in projects about adult safeguarding, this meeting provided an interesting insight into the CQC’s vision for regulation. Plans for the CQC to carry out more stringent inspections of social care services and to use their powers to encourage more effective joined-up working across health and social care sounded highly positive aspirations—although the policy shift to more infrequent inspections of the ‘best homes’ needs to be tempered by an acknowledgement of the risks of such homes being quick to deteriorate.

Caroline Norrie is Research Fellow at the Social Care Workforce Research Unit at King’s College London. Esther Njoya is a Research Intern at the Unit.

Nearly there? The Care Bill and adult safeguarding

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Caroline Norrie and Katie Graham provide an update on the progress of the Care Bill through Parliament with particular reference to its impact on adult safeguarding.

The Care Bill—described as “the biggest overhaul of social care rules for 65 years” (The Guardian, 9 October, 2013)—had its first reading in the House of Commons last week after completing its passage through the House of Lords. The scope of the Bill is extensive, attempting to amalgamate the dispersed and patchy adult social care legislation and including stipulations around social care assessment and funding changes. However, as researchers working on a project about adult safeguarding, we have been following the new adult safeguarding components of the Bill with much interest.

Katie attended the second reading of the Bill on 22 May. Lord Howe presented wellbeing as a central principle of the Bill whilst outlining plans for care funding arrangements (following, though not implementing, all Dilnot’s recommendations), a response to the Francis Report (not including the recommended regulation of social care and health care assistants), a strengthening of carers’ rights and a commitment to place adult safeguarding on a statutory footing.

The principles behind the Bill appeared to be welcomed by many of the speakers that day in the House, although with important caveats. Lord Howe alluded to one of the fundamental difficulties enacting the vision when saying “[a]s a nation we are living longer, which I am sure all noble Lords welcome. Managing the fiscal consequences of this will be a key challenge in the coming years”. Baroness Wheeler brought into stark reality the dire state of local authority funding, highlighting that councils “…by the end of this spending round, will have been stripped of £2.7 billion from their adult social care services, equivalent to 20% of their care budgets, as demand for services increases”.

More recently Caroline attended the House of Lords to listen to amendments tabled at the Bill’s 1st sitting of the report stage on 9 October. Discussions included an amendment which was successfully tabled by the Patron of Action on Adult Abuse, Baroness Greengross, to introduce a duty on councils to provide people with an independent advocate during assessment and support planning if they would otherwise have difficulty in understanding or communicating information, and have no one else to represent them.

Baroness Greengross also proposed amendments aimed at giving social workers powers to obtain court orders to gain access to enter private homes where they suspect a vulnerable adult is being abused but coerced into silence. These amendments were defeated with ministers arguing that existing legal powers were sufficient and social workers needed to improve their skills and knowledge in applying them to protect adults. (Power of entry is already available to social workers in Scotland.)  A survey of The College of Social Work members last year showed strong support for a qualified power of access by a social worker to interview a vulnerable adult where this was being blocked by a third party. Lobbying on this issue continues.

Other elements of the Bill with specific implications for safeguarding practice include:

Enquiries by Local Authorities

The Care Bill proposes a new legal duty for local authorities to make enquiries when they have a reasonable cause to suspect that an adult in their area has a need of care and support, is at risk of abuse and neglect and is unable to protect him or herself. The local authority must make whatever enquiries it thinks necessary to enable it to decide whether any action should be taken in that adult’s case. The Care Bill also confirms, for the first time in law, that “abuse” includes financial abuse. That includes having money or property stolen; being defrauded; being put under pressure in relation to money or other property; and, having money or other property misused. Advocacy organisations including The College of Social Work have been active in lobbying to ensure that people with complex needs are assessed by ‘appropriately qualified staff’.

Safeguarding Adults Boards

Safeguarding Adults Boards are to become statutory and to be composed of multi-disciplinary members. Again, The College of Social Work, amongst others, has been vocal in lobbying to ensure that the local authority representative on safeguarding adult boards should be social work-qualified.

Safeguarding Adult Reviews

The Care Bill proposes local authority Safeguarding Adults Boards must carry out a formal case review if an adult at risk in their area dies in circumstances where abuse or neglect are known or suspected. It must also carry out a review if it suspects that an adult has experienced serious abuse or neglect. Any review must identify the lessons to be learnt from that adult’s case, and apply those lessons to future cases. The stated aim of a review will be to ensure that lessons are learned from such cases; not to allocate blame, but to improve future practice and partnership working, to minimise the possibility of it happening again. With regard to this issue, The College of Social Work has argued for Safeguarding Adult Review teams to “include a social worker with substantial experience of safeguarding work”. Our Unit continues its work on the current system of Serious Case Reviews for adults.

Last week saw the third reading of the Bill in the Lords; a time for tweaking with no major changes suggested. However, there was considerable discussion over an amendment that was tabled, but which after discussion was removed. This focused on safeguarding of vulnerable adults in ‘approved premises’. Lord Patel of Bradford argued that vulnerable people in probation services are not adequately catered for in the Bill and called for a review on “the discharge by probation trusts of their responsibilities for safeguarding adults residing in approved premises” a year after the enactment of the Bill. Lord Patel argued that planned privatisation of probation provision could make it difficult to ensure effective safeguarding provision for those people using probation services. This abandoned amendment raised once more the question of the clarity of roles and responsibilities of all agencies working with people who may be at risk of abuse.

When summing up her contribution to the second reading of the Bill Baroness Campbell said that much depends “on how local authorities choose to implement their responsibilities and powers under this legislation. There is a great danger that this Bill could be ignored as fine words but without teeth”. We await to see what changes, if any, will be made to the Care Bill as it now proceeds through the House of Commons.

Caroline Norrie and Dr Katie Graham are both researchers at the Social Care Workforce Research Unit, King’s College London. They are working on: Models of safeguarding: a study comparing specialist and non-specialist safeguarding teams for adults – currently in its fieldwork stage.